Commentary

Scoring patients for VBAC


 

References

In “VBAC: Safer than you think” [August], Ellen Mozurkewich, MD, recommends carefully selecting patients for vaginal delivery after cesarean (VBAC). However, she does not offer clear guidelines for such a selection process. Here at Elmhurst Hospital Center-Mt. Sinai affiliation, we utilize a scoring system to identify candidates at low, medium, and high risk for VBAC (Table 1). While patients who score from 16 to 20 points are considered low-risk and, therefore, good candidates for VBAC, patients who score 0 to 5 points are considered high-risk and should never be offered a trial of labor. Medium-risk patients, scoring from 6 to 15 points, require individualized consideration with extensive counseling.

—E. HAKIM-ELAHI, MD
CHIEF OF WOMEN’S HEALTH SERVICES
ELMHURST HOSPITAL CENTER
ELMHURST, NY

TABLE 1

VBAC risk scoring system*,

SCORE 2 FOR EACH ITEMSCORE 1 FOR EACH ITEMSCORE 0 FOR EACH ITEM
Past:
1 cesarean2 cesareansMore than 2 cesareans
2-layer closure2-layer closure, with postoperative fever1-layer closure
Cesarean more than 2 years agoCesarean 1-2 years agoCesarean less than 1 year ago
Cesarean not due to CPDCesarean performed due to dystociaCesarean performed due to CPD
Term vaginal birthPremature vaginal birthNo vaginal birth
Present:
SingletonTwins (both cephalic)Twins (only first cephalic)
CephalicBreechOther presentations
Fetal weight less than 3,500 gFetal weight 3,500-4,500 gFetal weight above 4,500 g
Expect spontaneous laborExpect labor will need augmentationExpect labor will need to be induced
Maternal weight less than 170 lbsMaternal weight 171-250 lbsMaternal weight above 250 lbs
CPD = cephalopelvic disproportion; VBAC = vaginal birth after cesarean
*Low risk: 16-20 points; medium risk: 6-15 points; high risk: 0-5 points
Score 0 for each item you cannot document from history.

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